TikiTorches

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Well that's one way to look at it. In most cases it's probably just to ensure patient safety.
The Physician's in those systems are too busy churning rvus themselves. Many don't have time to properly supervise
 
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Hi everyone! I am currently a senior getting ready to apply for college and I don’t know if I should go the nursing route ( to eventually become an NP) or the PA route. I wanted to go pre-med for a while, but after reading into it a little more (in terms of time in school, debt, lifestyle etc) I don’t think it’s for me. I would like to work in pediatrics or neonatology for sure, and if possible, have some type of leadership position or teaching role in addition to being an NP or PA. I love the work of a NICU nurse and can definitely see myself doing that, but I also would love being a primary care provider in Pediatrics. I don’t know if this matters, but I also would like to have a big family someday and thus, would prefer somewhat of a regular work schedule so I can spend a lot of time at home. Which route would be the best given my preferences?

PLEASEEEE if you originally wanted to do pre-med, BECOME A DOCTOR! Everything you just stated sounds like -“you want to be a doctor but you to think PA/NP will be more convenient/cheaper route” This is not true. There are no shortcuts to success.

Myth #1: debt: Education itself has become ridiculously overpriced, so I don’t know why ppl believe education debt is only unique to physicians.
The avg PA student graduating debt is $150k -200k in 2018 (taken from the AAPA website). The avg debt for graduating med student in 2019 was $201k (AAMC website). I’m not gunna research NP, but I’m sure it’s not cheap. Regardless the route, There are tonnnnsss of programs and hospitals that pay back your debt, especially if you want to do primary care.

#Myth #2: Time in school: All of these programs are post-bachelor. PA 2-3years, NP mostly 3), MD/DO (4 years). That is one extra year! RESIDENCY is not school! It is work + education, that’s it!
Now, ppl argue “but PAs/NPs are making more money than a resident”. Yes, but that logic is also flawed. Example: The avg PA salary 2020 is $112k (AAPA website). The avg physician salary 2020 is $294k (medscape). So yea, you will be making $65k as a resident for 4yrs (average) while your friend who started PA school the year you started med school has been making $112k. Now math question, how many years will it take, after you finish residency, for your lifetime earnings to “catch up” with your PA friend? I did the math for you: ONLY 2 years and 3 months!!

I crunched those numbers just to show - don’t choose medicine because of money, HOWEVER, don’t let money deter you. (Same for NP).

Myth #3 s Finally lifestyle. lifestyle in medicine is SPECIALTY specific, not profession specific. I am a resident, my best friend is a neurosurgery OR nurse. she works the same, and many times, more hours than me. I will be graduating residency at 29. I’m married to my “med school sweetheart” (half of every med school class gets married to eachother - it’s a true phenomena lolll). We are planning to have 4kids and we are both physicians. I just signed my first contract out of residency - $375k/yr in a low cost of living city. Hours: M-F 6am-2:30p. No overnight calls, no weekends, no holidays. I will not miss a single holiday with my family nor a weekend kids soccer game. Each year I stay, my salary is increased by 25k (for the same hours), and it is capped at 400k. Any extra income I want, I am given the option to pick up shifts. Oh yea, 8 weeks vacation/year. My job is considered a “mommy track job”, sounds do-able right?

I took the time to write this because I’m tired of fellow women being deterred by myths.
 
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emergentmd

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PA = Much harder to get into. More knowledgeable when done with school. Less independence in some states
NP = Any nurse can become an NP. Less knowledgeable when done with school. More independence in some states.

Fast forward 1 yr
PA/NP = Similar skills/knowledge once trained. Essentially equivalent marketability.

Ubiquitous online NP schools has marginalized PA degrees. The AANP better start regulating b/c if the multitude of online schools will make NPs/PAs no better than a pharmacy degree. Hospitals/Physicians can care less where a PA/NP graduated from. All they care is they have the credentials to do the job. Sounds similar to pharmacist.

I am already seeing NPs/PAs have difficulty finding jobs.
 
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And please don’t be swayed by all the comments of “yeah I’m supervised but I have so much autonomy, the physician trusts me/gives me free reign blah blah”
PAs and NPs operate similarly to Residents, and residency sucks.
The supervising doc is not giving the NP/PA free reign because “they are so qualified and competent and blah blah blah”. The doc is just taking advantage of the fact that he/she has someone to do all his/her work for them. Do all the procedures (both fun and boring ones), deal with the patient drama and their families, deal with the medical team drama, write all the notes, answer all the pages, order all the lab work.
What people are calling “autonomy” while being supervised is in reality just scut work.
 
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emergentmd

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You are looking at a wide view. sure the debt/years are similar. Hell, Physical therapist is takes just as long with worse income potential.

The difference is the suffering difference during your 20's.

I went through a highly competitive Engineering college and essentially made a 4.0 and skated through it. Med school was like a going from college to the NFL where you are being hit by a 250lb linebacker with 4.4 speed rather than a 180lb cornerback with 4.4 speed. Yeah they are just as fast, but man that pain is different.

I am quite sure nursing school is MUCH easier than my engineering degree. Then these same nurses will do online NP school while holding down a full time job. This would be like being hit by a 125lb HS track guy running 4.4 speed.
 
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TikiTorches

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PLEASEEEE if you originally wanted to do pre-med, BECOME A DOCTOR! Everything you just stated sounds like -“you want to be a doctor but you to think PA/NP will be more convenient/cheaper route” This is not true. There are no shortcuts to success.

Myth #1: debt: Education itself has become ridiculously overpriced, so I don’t know why ppl believe education debt is only unique to physicians.
The avg PA student graduating debt is $150k -200k in 2018 (taken from the AAPA website). The avg debt for graduating med student in 2019 was $201k (AAMC website). I’m not gunna research NP, but I’m sure it’s not cheap. Regardless the route, There are tonnnnsss of programs and hospitals that pay back your debt, especially if you want to do primary care.

#Myth #2: Time in school: All of these programs are post-bachelor. PA 2-3years, NP mostly 3), MD/DO (4 years). That is one extra year! RESIDENCY is not school! It is work + education, that’s it!
Now, ppl argue “but PAs/NPs are making more money than a resident”. Yes, but that logic is also flawed. Example: The avg PA salary 2020 is $112k (AAPA website). The avg physician salary 2020 is $294k (medscape). So yea, you will be making $65k as a resident for 4yrs (average) while your friend who started PA school the year you started med school has been making $112k. Now math question, how many years will it take, after you finish residency, for your lifetime earnings to “catch up” with your PA friend? I did the math for you: ONLY 2 years and 3 months!!

I crunched those numbers just to show - don’t choose medicine because of money, HOWEVER, don’t let money deter you. (Same for NP).

Myth #3 s Finally lifestyle. lifestyle in medicine is SPECIALTY specific, not profession specific. I am a resident, my best friend is a neurosurgery OR nurse. she works the same, and many times, more hours than me. I will be graduating residency at 29. I’m married to my “med school sweetheart” (half of every med school class gets married to eachother - it’s a true phenomena lolll). We are planning to have 4kids and we are both physicians. I just signed my first contract out of residency - $375k/yr in a low cost of living city. Hours: M-F 6am-2:30p. No overnight calls, no weekends, no holidays. I will not miss a single holiday with my family nor a weekend kids soccer game. Each year I stay, my salary is increased by 25k (for the same hours), and it is capped at 400k. Any extra income I want, I am given the option to pick up shifts. Oh yea, 8 weeks vacation/year. My job is considered a “mommy track job”, sounds do-able right?

I took the time to write this because I’m tired of fellow women being deterred by myths.
Not everyone can get into med school. Once in, the competition is fierce give the level of the other students. The tests are very difficult. 3 usmle and the csa. Not comparable
 

TikiTorches

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You are looking at a wide view. sure the debt/years are similar. Hell, Physical therapist is takes just as long with worse income potential.

The difference is the suffering difference during your 20's.

I went through a highly competitive Engineering college and essentially made a 4.0 and skated through it. Med school was like a going from college to the NFL where you are being hit by a 250lb linebacker with 4.4 speed rather than a 180lb cornerback with 4.4 speed. Yeah they are just as fast, but man that pain is different.

I am quite sure nursing school is MUCH easier than my engineering degree. Then these same nurses will do online NP school while holding down a full time job. This would be like being hit by a 125lb HS track guy running 4.4 speed.
Yes and the undergrad for premed is very different from pre nursing
 
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Not everyone can get into med school. Once in, the competition is fierce give the level of the other students. The tests are very difficult. 3 usmle and the csa. Not comparable

Who said I was comparing the competitiveness of med school vs NP/PA? The original poster is a rising freshman who hasn’t even started college. If she wants to be a doctor, enter college with that plan and see how it goes. If she can’t get in, then reconsider other options. I’m saying, she shouldn’t automatically take herself out the running b/c of inaccurate assumptions about debt, length of training, and lifestyle.
 
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You are looking at a wide view. sure the debt/years are similar. Hell, Physical therapist is takes just as long with worse income potential.

The difference is the suffering difference during your 20's.

I went through a highly competitive Engineering college and essentially made a 4.0 and skated through it. Med school was like a going from college to the NFL where you are being hit by a 250lb linebacker with 4.4 speed rather than a 180lb cornerback with 4.4 speed. Yeah they are just as fast, but man that pain is different.

I am quite sure nursing school is MUCH easier than my engineering degree. Then these same nurses will do online NP school while holding down a full time job. This would be like being hit by a 125lb HS track guy running 4.4 speed.

Suffering through your 20s? Stop being dramatic. Your 20s are literally meant for painful growth and laying down the foundation for the rest of your life. That is a fact regardless what your career is. Yes med school is def harder than PA/NP school, however unless you’ve been med school, PA/NP will still feel like the most difficult thing you’ve done in your 20s. Therefore if you want to be a physician, go for it, and see how it goes , don’t cop out and do PA/NP because of societal myths
 
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Emedpa

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And please don’t be swayed by all the comments of “yeah I’m supervised but I have so much autonomy, the physician trusts me/gives me free reign blah blah”
PAs and NPs operate similarly to Residents, and residency sucks.
The supervising doc is not giving the NP/PA free reign because “they are so qualified and competent and blah blah blah”. The doc is just taking advantage of the fact that he/she has someone to do all his/her work for them. Do all the procedures (both fun and boring ones), deal with the patient drama and their families, deal with the medical team drama, write all the notes, answer all the pages, order all the lab work.
What people are calling “autonomy” while being supervised is in reality just scut work.
I agree that this is true in many places, especially for new grads. There are, however, a number of experienced/senior PAs/NPs practicing without physicians present, many in states that require no formal chart review. I work solo 24 hr shifts in multiple rural, critical access hospital emergency departments. I have a sponsoring physician of record, but see every patient, write every chart, do every procedure, and take care of all floor emergencies as the only provider in the facility when the hospitalist is away (20 hrs/day). This is the holy grail for emergency medicine PA practice. I don't know the stats for NPs who do this, but only 2.5% of EM PAs practice solo without a backup physician available. In round figures, that means there are probably 250 solo EM PA jobs in the whole country. All of this being said, if I could do life over I would go to medschool and try to land an EM/FP residency slot. I like where I am at now in life, but it hasn't been a pleasant road to get here. Lots of crappy jobs, bad bosses, etc. I drive 1200 miles a month just to go to and from work. It is worth it.
 

TikiTorches

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Suffering through your 20s? Stop being dramatic. Your 20s are literally meant for painful growth and laying down the foundation for the rest of your life. That is a fact regardless what your career is. Yes med school is def harder than PA/NP school, however unless you’ve been med school, PA/NP will still feel like the most difficult thing you’ve done in your 20s. Therefore if you want to be a physician, go for it, and see how it goes , don’t cop out and do PA/NP because of societal myths
Wasnt all that painful for my college friends who did 4 years of non science and non engineering majors and went directly to careers. They were partying while i was studying and going to labs in addition to class, studying for mcats, etc.
Those students are the majority of students who graduate college... youre being the dramatic one.
 
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TikiTorches

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I agree that this is true in many places, especially for new grads. There are, however, a number of experienced/senior PAs/NPs practicing without physicians present, many in states that require no formal chart review. I work solo 24 hr shifts in multiple rural, critical access hospital emergency departments. I have a sponsoring physician of record, but see every patient, write every chart, do every procedure, and take care of all floor emergencies as the only provider in the facility when the hospitalist is away (20 hrs/day). This is the holy grail for emergency medicine PA practice. I don't know the stats for NPs who do this, but only 2.5% of EM PAs practice solo without a backup physician available. In round figures, that means there are probably 250 solo EM PA jobs in the whole country. All of this being said, if I could do life over I would go to medschool and try to land an EM/FP residency slot. I like where I am at now in life, but it hasn't been a pleasant road to get here. Lots of crappy jobs, bad bosses, etc. I drive 1200 miles a month just to go to and from work. It is worth it.
Yep and if there's any complaints or lawsuits that md will take the hit.
 

Emedpa

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Yep and if there's any complaints or lawsuits that md will take the hit.
This is going away in many states. see the Michigan law update here:
Critically, HB 5533 makes PAs responsible for their professional actions. Studies have documented that PAs provide high quality cost-effective medical care. Physician liability for PA care is no longer necessary and its elimination removes an undue burden on physicians.
This is a goal for the PA profession in every state. We agree we should be responsible for our actions and that the physicians we work with should only bear responsibility if they are directly involved in that care themselves.
 

emergentmd

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Suffering through your 20s? Stop being dramatic. Your 20s are literally meant for painful growth and laying down the foundation for the rest of your life. That is a fact regardless what your career is. Yes med school is def harder than PA/NP school, however unless you’ve been med school, PA/NP will still feel like the most difficult thing you’ve done in your 20s. Therefore if you want to be a physician, go for it, and see how it goes , don’t cop out and do PA/NP because of societal myths

You are painting something with a large brush. You stated " I am a resident, my best friend is a neurosurgery OR nurse. she works the same, and many times, more hours than me. "

What does your nurse friend working more hours than you have to do with anything. I have a friend that plays poker for a living doing it 60hrs a week so what does this have any relevance to the discussion?

You also are twisting my words to back up your false beliefs. I never said a physician suffers or I suffered. But to compare the sacrifice/work of both fields is demeaning to the physician just as saying becoming a Navy seal is the same as going to ROTC b/c they both put in long hours is demeaning to the Seal.
 
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pamac

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Why do "independent" NP still have collaboration agreement with Physicians?

My rn patients are saying there's a shortage of RN as many young nurses are going to Np school. There will be a glut...

That’s very touching of you to express concern regarding the potential for an RN shortage due to all of the nurses upgrading to becoming NPs.

The good news is that NPs can work as RNs if they need to until they land a job. If there is a glut, the market can adjust.

When I left my RN career to become an NP, I went from making $85k to making around double that. I went from working 12.5 hour shifts to working more tolerable hours. I was a day shift worker, but also worked much of my career at night, and as an NP I now work days. I went from having 1/2 hour lunches whenever I could fit it in to getting an hour at lunch time. I went from being glued to my unit the entire time I was at work to being able to come and go as I please. I went from never once being able to leave early or come in late to being able to leave whenever the work was done, and come in later if I don’t have patients scheduled. The list goes on. It’s so much better as an NP. My knowledge base is much greater. I enjoy the work so much more than I ever did as a nurse. It’s much more rewarding for me professionally, and it’s increased my ability to provide for my family to such a high degree that I have never once looked back. I’ve enjoyed making life better for my patients and saving more lives.

It’s unfortunate that you see all of that as a problem for you and your bottom line. That’s really the cusp of how you feel. Oh wait!.... patient care! Yeah you care about that so much. Bet you’d do your job for half as much as you do now if you had to, because money is just a side issue for you.

There will always be a need for doctors. That won’t go away. They know that. They also know that the biggest threat out there isn’t to patients, it’s to the bottom line for physicians. I get that they should be paid well. I have no problem when I started as a new NP making 50% of what the experienced physicians in my office make. But the fear of being replaced is overblown. Call me when there aren’t legions of students lined up to go to medical school because they all want to be NPs. Then you know there’s a crisis brewing. Besides, if there is a problem with NPs displacing docs, it’s because physician medical directors, and physician practice owners are deciding to hire NPs over docs for profit margins. Talk to your buddies.
 
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pamac

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This is going away in many states. see the Michigan law update here:
Critically, HB 5533 makes PAs responsible for their professional actions. Studies have documented that PAs provide high quality cost-effective medical care. Physician liability for PA care is no longer necessary and its elimination removes an undue burden on physicians.
This is a goal for the PA profession in every state. We agree we should be responsible for our actions and that the physicians we work with should only bear responsibility if they are directly involved in that care themselves.

NPs just obtained independence in California (albeit with some changes to the law that will be made within a few years to make it more palatable, and that CNA will continue to lobby hard for). Yet PAs are excited to have nominal practice freedom in one state. But it’s progress that you endorse independence for non physician providers. Unfortunately, the independence cruise ship is sailing, and PAs aren’t on board. They are in a canoe chasing that steamship upstream. California, man. Biggest state in the Union. Before that it was Florida the year previous, and that surprised even me. The momentum for NPs is independence. The momentum for PAs is.... some idea that takes more than a paragraph to explain to the lay person. While PAs were telling everyone that “PAs are better, Y’all”, NPs went and expanded their realm.
Going forward, physicians aren’t going to let another nonphysician provider out of the barn. Whatever they let PAs get away with, you can bet it stops short of something that they feel threatened by. Look at how upset folks like TackiTorches is at the notion of NPs costing him the equivalent of a new entry level Tesla over the course of his entire career. Imagine how he will feel about a PA threatening to hang a sign that says “Mr emedpa, PA (not quite a doctor, but way better than an NP)”. The check to an independent PA still heads to the PAs bank account without stopping to pay for the tricked out minivan the docs wife just bought.
 
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pamac

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Wasnt all that painful for my college friends who did 4 years of non science and non engineering majors and went directly to careers. They were partying while i was studying and going to labs in addition to class, studying for mcats, etc.
Those students are the majority of students who graduate college... youre being the dramatic one.

And now you have a career that gives you an earning potential that can be counted upon to be phenomenal compared to any other degree field. Yes, some MBAs go on to be executives, and some lawyers go on to be partners. The vast majority don’t. Physicians are set up to do quite well at a minimum... AS AN EXPECTATION. So while medical school is hard, when you treat it like a day job, there are a lot of similarities to what other new workers put in during their 20’s. For med students, I think it’s more consistently difficult overall, and residency seems rough. But I think a lot of med students miss the fact that lots of other jobs are hard, and involve a trade off. My trade off was I worked full time my entire adult life. Had I opted to pull out student loans, id be in debt. Most medical students opt to take out loans and focus on school. And then they hit the jackpot.

One thing I really admire about physicians is how well they delay gratification. Everyone could learn from that.
 
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pamac

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Yep and if there's any complaints or lawsuits that md will take the hit.

Cool. There’s a case for independence for PAs and NPs. I guess you are onboard.

Physicians are targeted because you guys have the money that the lawyers want to take from you. And when a PA is involved, that’s double the payout, because you know the law dogs will be going for both the PA and MD/DO insurance company payouts due to you guys “being a team”. So if EmedPA screws up while running solo in the rural facility that he works at, his sponsoring/supervising/collaborating physician will also be invited to opine via deposition as to why they felt comfortable having so much daylight between themself and EmedPA as far as oversight.
 
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Emedpa

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NPs just obtained independence in California (albeit with some changes to the law that will be made within a few years to make it more palatable, and that CNA will continue to lobby hard for). Yet PAs are excited to have nominal practice freedom in one state. But it’s progress that you endorse independence for non physician providers. Unfortunately, the independence cruise ship is sailing, and PAs aren’t on board. They are in a canoe chasing that steamship upstream. California, man. Biggest state in the Union. Before that it was Florida the year previous, and that surprised even me. The momentum for NPs is independence. The momentum for PAs is.... some idea that takes more than a paragraph to explain to the lay person. While PAs were telling everyone that “PAs are better, Y’all”, NPs went and expanded their realm.
Going forward, physicians aren’t going to let another nonphysician provider out of the barn. Whatever they let PAs get away with, you can bet it stops short of something that they feel threatened by. Look at how upset folks like TackiTorches is at the notion of NPs costing him the equivalent of a new entry level Tesla over the course of his entire career. Imagine how he will feel about a PA threatening to hang a sign that says “Mr emedpa, PA (not quite a doctor, but way better than an NP)”. The check to an independent PA still heads to the PAs bank account without stopping to pay for the tricked out minivan the docs wife just bought.
MI was just the first. Several states have followed suit since 2016. A few even have independent PA medical boards now. One of the major issues physicians have with non-physician providers is liability. Legislation like this takes the physician's liability away. I was not trying to make this a PA vs NP response, just to highlight the progress being made recently by PAs. Yes, we are 20 years behind the NPs, but we are making progress. I said nothing derogatory about NPs. As mentioned elsewhere. I recommend PA to some folks and NP to others depending on their location and specialty preference.
 
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TikiTorches

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This is going away in many states. see the Michigan law update here:
Critically, HB 5533 makes PAs responsible for their professional actions. Studies have documented that PAs provide high quality cost-effective medical care. Physician liability for PA care is no longer necessary and its elimination removes an undue burden on physicians.
This is a goal for the PA profession in every state. We agree we should be responsible for our actions and that the physicians we work with should only bear responsibility if they are directly involved in that care themselves.
We will see. The not every state and it will take time to get the approvals. Many corporation still have a Physician supervisor no matter what.
 

TikiTorches

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This is going away in many states. see the Michigan law update here:
Critically, HB 5533 makes PAs responsible for their professional actions. Studies have documented that PAs provide high quality cost-effective medical care. Physician liability for PA care is no longer necessary and its elimination removes an undue burden on physicians.
This is a goal for the PA profession in every state. We agree we should be responsible for our actions and that the physicians we work with should only bear responsibility if they are directly involved in that care themselves.
If they are attached at all like your guy who is supposedly collaborating it will hit the doc. They can always sue you both. The the way it's don3
 
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No, it wouldn’t stand to reason that NPs shouldn’t be able to practice independently. Even if they are the folks with the weakest admission standards of the three, they are in good company. It’s the same reason that not every pilot needs to be able to fly the space shuttle. Yes, the role of RN and NP are a lot different, but I’d argue that the realm of having a high level of responsibility is what sets RN HcE apart from folks without it. Pretty much the only folks that settle in close to them might be experienced professional paramedics.

I’ve been an advocate for PAs being independent as well, but I just don’t see how that happens because you guys are locked in by the system. The reason I’m comfortable with PAs being independent is because on a daily basis, how much supervision are you guys really clinging to? How much of that check and balance takes place day to day? It’s a formality, but one that keeps you guys in an awkward employment relationship. Whatever the case, the physicians have literally all the say over how you operate, and your only choice is to leave or stay. That’s weird to me given that PAs tend to be excellent providers on the whole.

NPs practice independently in about half of all states right now, with no evidence that outcomes are any worse in states that allow independence vs those that don’t. In fact, the states that don’t allow independence for NPs keep company with states with some of the worst healthcare outcomes out there, vs some of the healthiest states allowing independent practice for NPs. California just created a pathway for independence for NPs after a few years supervision, and in a few years I expect that the time requirement will be lifted just like all of California’s neighbors. The same thing is happening in Florida. Virginia and Illinois have a similar time requirement before NPs can work independently. So it’s happening, and it’s going to be just fine, just like things are in my state. Doctors won’t go away. They won’t have to “supervise” NPs and risk their licenses like kikiscorches insists he is not willing to do (which is funny because where I work, they would just tell him “fine, take a hike if you won’t supervise like we tell you to”). Maybe he’s valuable enough to tell admin to pound sand, but times are a bit different than they used to be before most physicians were employees.

In any event, I am friends with PAs, NPs, and physicians. The professional atmosphere is excellent. Right now, I too am a bit put off by the legions of RNs becoming NPs, but I also am realistic in my thinking that I’d rather put up with that and be independent than throw the baby out with the bath water. I do like the option I have to go out and own my own business, and not have to pay a physician for the formality of “supervising” me. I like that I don’t have to worry about a supervising physician’s license, in addition to my own. In my specialty, if I was a dependent PA, I’d make roughly $60k less than I do now, because my employers know I can leave and do my own thing and do well if they don’t keep me happy. And I am truly mobile. I could leave tomorrow and open up a cash pay practice and have patients within a week. And many or most PAs with psyche skills could do that too, if not for the formalities involved in their chosen career.

With all due respect, that logic is obtuse. It is not difficult, by any means, to obtain admission into an NP program. If you are in agreement that NP educational standards are far below that of PAs and physicians, again, why would they be allowed the greatest amount of independence? Physicians spend YEARS becoming proficient clinicians. During that time they are supervised. NPs have bypassed that system through legislation. I never advise a patient to seek care from an APN that isn’t supervised and I am meaningful in teaching patients the difference between “dependent” and “independent” practice. My colleagues, NPs included, are also quick to educate.

Also, what is meant by “they are in good company”? Again, admission standards and educational standards for PAs, DOs, and MDs are far more rigorous. Maybe you can find some outliers, but overall NP education is in painful need of repair. Surely you acknowledge that?
 
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pamac

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You seem to conveniently place PA’s closer to the MD’s and DO’s. Under the best of circumstances, they regard you as such:

NP<PA<<<<<<<<<<<<<<<<<<<<DO<MD.

I’m not held in awe by your year of in-class study, and your year of clinical rotations, but apparently you place it up there next to the MD’s and DO’s.

What I mean by good company is clear, but I’ll un-obtuse it for you: Outcomes aren’t clearly lacking.

You also conveniently suggest that I am in agreement that NP standards are “far” below that of “PA’s and physicians”. I said no such thing. Again, you lump yourself in with physicians. At best, I would suggest that NP training is not as rigorous in and of itself than PA school, but I think we both could reasonably agree that both PA and NP training is quite a bit less rigorous than physicians go through.

The only person here presenting an “obtuse” argument is you, by repeatedly trying to lump yourself in with physicians as some kind of appeal based on that false association.
 
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You seem to conveniently place PA’s closer to the MD’s and DO’s. Under the best of circumstances, they regard you as such:

NP<PA<<<<<<<<<<<<<<<<<<<<DO<MD.

I’m not held in awe by your year of in-class study, and your year of clinical rotations, but apparently you place it up there next to the MD’s and DO’s.

What I mean by good company is clear, but I’ll un-obtuse it for you: Outcomes aren’t clearly lacking.

You also conveniently suggest that I am in agreement that NP standards are “far” below that of “PA’s and physicians”. I said no such thing. Again, you lump yourself in with physicians. At best, I would suggest that NP training is not as rigorous in and of itself than PA school, but I think we both could reasonably agree that both PA and NP training is quite a bit less rigorous than physicians go through.

The only person here presenting an “obtuse” argument is you, by repeatedly trying to lump yourself in with physicians as some kind of appeal based on that false association.

I have a PA student working with my physician group right now. I’ve seen many before him. He sits silently at the computer all day. Writes two notes. Doing homework. I’m FAR from impressed. I got far more patient exposure during my “awful” NP clinicals.
 

Emedpa

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I have a PA student working with my physician group right now. I’ve seen many before him. He sits silently at the computer all day. Writes two notes. Doing homework. I’m FAR from impressed. I got far more patient exposure during my “awful” NP clinicals.
That is more about the students than their programs of study. I have had great NP students and terrible PA students and vis versa. I encourage all my students (MD/DO/Resident/PA/NP/Medic) to be very involved in patient care, ask lots of questions, and research stuff they don't know(yet).
 
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pamac

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I have a PA student working with my physician group right now. I’ve seen many before him. He sits silently at the computer all day. Writes two notes. Doing homework. I’m FAR from impressed. I got far more patient exposure during my “awful” NP clinicals.
That is more about the students than their programs of study. I have had great NP students and terrible PA students and vis versa. I encourage all my students (MD/DO/Resident/PA/NP/Medic) to be very involved in patient care, ask lots of questions, and research stuff they don't know(yet).

Prior to COVID, NP programs got a lot of flack about being online. I love online learning, and loved the online components of my NP program. I’ve talked to PA and medical students who have enjoyed their unexpected transition to online. Initially, there was frustration because being in class forced their attention to the material. But the majority of folks seemed to come to appreciate the flexibility (for those who were offered any... because not all were allowed to do things in their own time frame). So while many of my NP peers may be attending a program of low quality, they aren’t prisoners of that. You can put time into what you want to and come out ahead. So while there may be variability between each NP student, it doesn’t bug me much because I put in effort where I felt I needed to for me to be successful. That doesn’t work for everyone, and slackers can slip through. I don’t worry about everyone else, I worry about me. I worked hard against the odds to find world class clinical rotations. And those rotations all turned into job offers. I cultivated those rotations long before any deadlines, sometimes years ahead of schedule. And yet I still get emails from students begging have me host them a few weeks before they want to start. It’s a box to check for some students. They will get out of it what they put into it. A lot of NP students and new grads are finding that out right now. It doesn’t mean I don’t think we should be allowed to be independent. It’s handy, and it’s really not as dramatic as haters make it out to be.
 
Aug 23, 2020
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PLEASEEEE if you originally wanted to do pre-med, BECOME A DOCTOR! Everything you just stated sounds like -“you want to be a doctor but you to think PA/NP will be more convenient/cheaper route” This is not true. There are no shortcuts to success.

Myth #1: debt: Education itself has become ridiculously overpriced, so I don’t know why ppl believe education debt is only unique to physicians.
The avg PA student graduating debt is $150k -200k in 2018 (taken from the AAPA website). The avg debt for graduating med student in 2019 was $201k (AAMC website). I’m not gunna research NP, but I’m sure it’s not cheap. Regardless the route, There are tonnnnsss of programs and hospitals that pay back your debt, especially if you want to do primary care.

#Myth #2: Time in school: All of these programs are post-bachelor. PA 2-3years, NP mostly 3), MD/DO (4 years). That is one extra year! RESIDENCY is not school! It is work + education, that’s it!
Now, ppl argue “but PAs/NPs are making more money than a resident”. Yes, but that logic is also flawed. Example: The avg PA salary 2020 is $112k (AAPA website). The avg physician salary 2020 is $294k (medscape). So yea, you will be making $65k as a resident for 4yrs (average) while your friend who started PA school the year you started med school has been making $112k. Now math question, how many years will it take, after you finish residency, for your lifetime earnings to “catch up” with your PA friend? I did the math for you: ONLY 2 years and 3 months!!

I crunched those numbers just to show - don’t choose medicine because of money, HOWEVER, don’t let money deter you. (Same for NP).

Myth #3 s Finally lifestyle. lifestyle in medicine is SPECIALTY specific, not profession specific. I am a resident, my best friend is a neurosurgery OR nurse. she works the same, and many times, more hours than me. I will be graduating residency at 29. I’m married to my “med school sweetheart” (half of every med school class gets married to eachother - it’s a true phenomena lolll). We are planning to have 4kids and we are both physicians. I just signed my first contract out of residency - $375k/yr in a low cost of living city. Hours: M-F 6am-2:30p. No overnight calls, no weekends, no holidays. I will not miss a single holiday with my family nor a weekend kids soccer game. Each year I stay, my salary is increased by 25k (for the same hours), and it is capped at 400k. Any extra income I want, I am given the option to pick up shifts. Oh yea, 8 weeks vacation/year. My job is considered a “mommy track job”, sounds do-able right?

I took the time to write this because I’m tired of fellow women being deterred by myths.
WOW! This is amazing, thank you so so much. You’re right that I am looking for an easier, less stressful path to becoming a Pediatrician, but I suppose there isn’t one. I think I’m gonna stay pre-med for now and make an official decision in college. We need more women in medicine anyways! Also, a few questions. What specialty are you in, and do you feel that the sacrifices you made (missed weddings, birthdays, outings etc) were worth it/would you do it again or is there anything you would do differently? My biggest concerns right now are the sacrifices and the possibility of not being able to spend time with family (which I now realize shouldn’t be a concern).
 

pamac

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WOW! This is amazing, thank you so so much. You’re right that I am looking for an easier, less stressful path to becoming a Pediatrician, but I suppose there isn’t one. I think I’m gonna stay pre-med for now and make an official decision in college. We need more women in medicine anyways! Also, a few questions. What specialty are you in, and do you feel that the sacrifices you made (missed weddings, birthdays, outings etc) were worth it/would you do it again or is there anything you would do differently? My biggest concerns right now are the sacrifices and the possibility of not being able to spend time with family (which I now realize shouldn’t be a concern).

60% of physicians under age 35 are female.

I think one way to look at the issue of quality time with your kids is to keep in mind income. As a physician, you can typically afford to work less because you make more. So while undergrad, medical school, and residency consume a great deal of time, once you are done, you can be making a good wage. In theory you can cut back to fewer days per week and end up making really decent money. But there are all sorts of variables. Some specialties are easier to work an abbreviated schedule than others. Also, there’s debt to pay back. Then there is all the money you are leaving on the table when you do that. Can you handle living a live with an abbreviated income as opposed to getting seduced by the extra cash and what it can do for you? Maybe you can.
Parenthood is rough on the schedule, though. I look back on all the time that goes into even simple tasks, and it’s a lot more than I expected. Moms seem to get it worse as far as societal expectations, peer expectations, and guilt they feel regarding what they see as parenting hiccups. I think it’s safe to say that NP and PA moms have similar challenges, but medical school is more intense.
 
Feb 14, 2020
11
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You seem to conveniently place PA’s closer to the MD’s and DO’s. Under the best of circumstances, they regard you as such:

NP<PA<<<<<<<<<<<<<<<<<<<<DO<MD.

I’m not held in awe by your year of in-class study, and your year of clinical rotations, but apparently you place it up there next to the MD’s and DO’s.

What I mean by good company is clear, but I’ll un-obtuse it for you: Outcomes aren’t clearly lacking.

You also conveniently suggest that I am in agreement that NP standards are “far” below that of “PA’s and physicians”. I said no such thing. Again, you lump yourself in with physicians. At best, I would suggest that NP training is not as rigorous in and of itself than PA school, but I think we both could reasonably agree that both PA and NP training is quite a bit less rigorous than physicians go through.

The only person here presenting an “obtuse” argument is you, by repeatedly trying to lump yourself in with physicians as some kind of appeal based on that false association.

You still haven’t answered my original question in regards to NP education and independent practice.

Stating that PA education and MD/DO education are superior to NP education does not equate to PA education is equivalent to physician education. You completely missed the point. My apologies for your apparent confusion.

I also have yet to meet a physician that has had any complaints of PA education, but I have definitely heard many complaints of NP education, but I’m glad that you have the ability to know “how they regard me.” I’ll let the completely oversaturated NP market near me decide NP vs PA education...which isn’t good for NPs. Perhaps they should also just practice independently and open up their own offices....
It’s not me conveniently placing PA education closer to MD/DO education. It’s just a simple fact that it is! Nursing education is not the same.
 
Jan 1, 2020
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You still haven’t answered my original question in regards to NP education and independent practice.

Stating that PA education and MD/DO education are superior to NP education does not equate to PA education is equivalent to physician education. You completely missed the point. My apologies for your apparent confusion.

I also have yet to meet a physician that has had any complaints of PA education, but I have definitely heard many complaints of NP education, but I’m glad that you have the ability to know “how they regard me.” I’ll let the completely oversaturated NP market near me decide NP vs PA education...which isn’t good for NPs. Perhaps they should also just practice independently and open up their own offices....
It’s not me conveniently placing PA education closer to MD/DO education. It’s just a simple fact that it is! Nursing education is not the same.

I’ve met tons of physicians who have a problem with PA and NP education. One year of classroom and one year of clinicals vs the 7 years for a physician? They look at us the same.
 
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pamac

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You still haven’t answered my original question in regards to NP education and independent practice.

Stating that PA education and MD/DO education are superior to NP education does not equate to PA education is equivalent to physician education. You completely missed the point. My apologies for your apparent confusion.

I also have yet to meet a physician that has had any complaints of PA education, but I have definitely heard many complaints of NP education, but I’m glad that you have the ability to know “how they regard me.” I’ll let the completely oversaturated NP market near me decide NP vs PA education...which isn’t good for NPs. Perhaps they should also just practice independently and open up their own offices....
It’s not me conveniently placing PA education closer to MD/DO education. It’s just a simple fact that it is! Nursing education is not the same.

Lol.... ok, let’s unpack some of your BS.

First, I’ll translate what you didn’t seem to understand, which was that I was suggesting that NPs are in good company because Docs, PAs and NPs all attend training that at least makes each of us qualified to practice at an independent level. You may not believe that you are qualified as a PA to do that, but I do. I guess we disagree, and that’s fine that I have more faith in your profession than you do. Water under the bridge. We can disagree on that and still be friends. Currently only docs and NPs practice independently, but in theory that could change for you guys.

That feeds into my next assertion that even if PA school is more in depth, that doesn’t mean that it forms the floor as far as the lowest level one can be trained at and still be qualified to prescribe. Again, myself and more than half of states disagree with you on that (because NPs in those places can practice independently), but no biggie. But I think you just might win the argument that PAs do not have adequate training to practice independently, because NO states whatsoever agree with me that you guys are qualified to practice independently. So I guess you beat me on that one. I’ll give credit where it’s due.

Some docs and med students might chime in and say “yeah dude, I totally agree that NPs are terrible.” Ok, fine.... N=1, N=2, N=3..... whatever. I still wake up tomorrow and have an independent license and go to work to practice independently. I have good outcomes with my patients. Another year goes by and another state or two allows NPs to practice independently. No biggie. How many states have backtracked? None. How many will? None.

But I still get a giggle at how you make claim on how every doc feels about this. Guess what I’ve found? Most don’t care one bit. It’s not even worth the time for the big shots. They lump us together. They can’t stop NPs from becoming independent, but they won’t let PAs do it. Thats how much they regard you guys, and that means more than any opinions you’ve gathered among the docs that you’ve supposedly queried on the subject of PA vs NP. So do they really regard you highly when they don’t want to let you guys work without a tether to them? I’d think that out of respect they would put their money where their mouth is and give you guys a leg up in life.

No? So they don’t want to pony up? Really? Even though you said they think you are all that? Funny....
 
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Lol.... ok, let’s unpack some of your BS.

First, I’ll translate what you didn’t seem to understand, which was that I was suggesting that NPs are in good company because Docs, PAs and NPs all attend training that at least makes each of us qualified to practice at an independent level. You may not believe that you are qualified as a PA to do that, but I do. I guess we disagree, and that’s fine that I have more faith in your profession than you do. Water under the bridge. We can disagree on that and still be friends. Currently only docs and NPs practice independently, but in theory that could change for you guys.

That feeds into my next assertion that even if PA school is more in depth, that doesn’t mean that it forms the floor as far as the lowest level one can be trained at and still be qualified to prescribe. Again, myself and more than half of states disagree with you on that (because NPs in those places can practice independently), but no biggie. But I think you just might win the argument that PAs do not have adequate training to practice independently, because NO states whatsoever agree with me that you guys are qualified to practice independently. So I guess you beat me on that one. I’ll give credit where it’s due.

Some docs and med students might chime in and say “yeah dude, I totally agree that NPs are terrible.” Ok, fine.... N=1, N=2, N=3..... whatever. I still wake up tomorrow and have an independent license and go to work to practice independently. I have good outcomes with my patients. Another year goes by and another state or two allows NPs to practice independently. No biggie. How many states have backtracked? None. How many will? None.

But I still get a giggle at how you make claim on how every doc feels about this. Guess what I’ve found? Most don’t care one bit. It’s not even worth the time for the big shots. They lump us together. They can’t stop NPs from becoming independent, but they won’t let PAs do it. Thats how much they regard you guys, and that means more than any opinions you’ve gathered among the docs that you’ve supposedly queried on the subject of PA vs NP. So do they really regard you highly when they don’t want to let you guys work without a tether to them? I’d think that out of respect they would put their money where their mouth is and give you guys a leg up in life.

No? So they don’t want to pony up? Really? Even though you said they think you are all that? Funny....
At my hospital, PA's and NP's are viewed and treated exactly the same. I can't tell you each physicians individual opinion but why does that even matter?
 
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Ho0v-man

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OP should go PA. If you change your mind and want to be a physician, the undergrad requirements are very similar for PA and MD/DO.

Going NP seems like a longer path just to avoid a little academic rigor. Why do 2 years of nursing if you KNOW that’s not what you want?

I’m probably going to offend some but I’ll be perfectly frank. I’ve reviewed PANCE and AANP certification materials. If you want an education, you should be a PA.
 
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pamac

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OP should go PA. If you change your mind and want to be a physician, the undergrad requirements are very similar for PA and MD/DO.

Going NP seems like a longer path just to avoid a little academic rigor. Why do 2 years of nursing if you KNOW that’s not what you want?

I’m probably going to offend some but I’ll be perfectly frank. I’ve reviewed PANCE and AANP certification materials. If you want an education, you should be a PA.

it certainly can be faster to just go to PA school, provided you have the prereqs already knocked out.
 
Feb 14, 2020
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Lol.... ok, let’s unpack some of your BS.

First, I’ll translate what you didn’t seem to understand, which was that I was suggesting that NPs are in good company because Docs, PAs and NPs all attend training that at least makes each of us qualified to practice at an independent level. You may not believe that you are qualified as a PA to do that, but I do. I guess we disagree, and that’s fine that I have more faith in your profession than you do. Water under the bridge. We can disagree on that and still be friends. Currently only docs and NPs practice independently, but in theory that could change for you guys.

That feeds into my next assertion that even if PA school is more in depth, that doesn’t mean that it forms the floor as far as the lowest level one can be trained at and still be qualified to prescribe. Again, myself and more than half of states disagree with you on that (because NPs in those places can practice independently), but no biggie. But I think you just might win the argument that PAs do not have adequate training to practice independently, because NO states whatsoever agree with me that you guys are qualified to practice independently. So I guess you beat me on that one. I’ll give credit where it’s due.

Some docs and med students might chime in and say “yeah dude, I totally agree that NPs are terrible.” Ok, fine.... N=1, N=2, N=3..... whatever. I still wake up tomorrow and have an independent license and go to work to practice independently. I have good outcomes with my patients. Another year goes by and another state or two allows NPs to practice independently. No biggie. How many states have backtracked? None. How many will? None.

But I still get a giggle at how you make claim on how every doc feels about this. Guess what I’ve found? Most don’t care one bit. It’s not even worth the time for the big shots. They lump us together. They can’t stop NPs from becoming independent, but they won’t let PAs do it. Thats how much they regard you guys, and that means more than any opinions you’ve gathered among the docs that you’ve supposedly queried on the subject of PA vs NP. So do they really regard you highly when they don’t want to let you guys work without a tether to them? I’d think that out of respect they would put their money where their mouth is and give you guys a leg up in life.

No? So they don’t want to pony up? Really? Even though you said they think you are all that? Funny....

I have no interest in arguing with you, as you so frequently do with individuals that may challenge your own preconditioned ideas.

You still have not answered the questions that I provided, which only speaks to the very answer that is blindingly obvious in regards to nursing vs medical education. NP education is in need of complete overhaul, and using your own personal anecdotes of overcoming your poor NP education in attempt to speak to how NP education should be, only further substantiates why not a single provider I know willingly sends their patients to psych nurses over psych physicians. I have sent this entire conversation to our group as evidence of personal discussions that happen on a near daily basis in our very large healthcare group.
 

TikiTorches

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I have Physician's who complain also about PA education as it is very truncated also.
 
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pamac

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I have no interest in arguing with you, as you so frequently do with individuals that may challenge your own preconditioned ideas.

You still have not answered the questions that I provided, which only speaks to the very answer that is blindingly obvious in regards to nursing vs medical education. NP education is in need of complete overhaul, and using your own personal anecdotes of overcoming your poor NP education in attempt to speak to how NP education should be, only further substantiates why not a single provider I know willingly sends their patients to psych nurses over psych physicians. I have sent this entire conversation to our group as evidence of personal discussions that happen on a near daily basis in our very large healthcare group.

I answered all of your questions, maybe not to your satisfaction, but that wouldn’t surprise me that you aren’t satisfied, given that you tend to declare victory unilaterally.

I have patients that I see literally every day that are direct referrals from physicians. For you to say that not a single provider you know “willingly” sends patients to psyche NPs is nonsense. If you did forward this to your group like you say, then you look like a fool for a number of reasons, so I actually hope you didn’t do that.

So answer this.... what would an “unwilling” referral by a physician to a Psych NP look like? Are you giving yourself room to suggest that physicians only send folks to psyche NPs when they “really, really” don’t want to deal with them on their own? What kind of patients would that be? The easy ones? The hard ones? I’m sure that answering my question paints you in a corner. If you say “the easy patients”, then why would they be sent at all? If you say “the hard patients” then it acknowledges that psyche NPs have a role in dealing with difficult cases. So what is it? Who would you say the doctors are sending me? Because you know that I am getting referrals from doctors. I wouldn’t be employed and making the money that I do if I wasn’t seeing healthy numbers of patients, and NPs and self referrals can’t be the sole source of my patient panel.

Dude, you are outmatched. Again, I hope the conversation here didn’t make it to anyone that you actually hope has a high opinion of you. They likely shake their heads at why you are fixated on this subject and seek to disparage colleagues. I’d be shocked if you and your practice mates (your supervising physicians et al.) really waste much of their time taking an active interest in NP topics. If so, you are allowing my profession to live rent free in your brain. I’ve been out and about in this field for several years, and I can’t think of a single time I’ve had a conversation about the educational requirements of PAs, or chiropractors, or PTs, or naturopathic doctors, etc. That’s just me, but seriously.... Np education comes up daily around you? Daily?
 

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